POS1223 DIFFERENT ANTI-SARS-CoV-2 VACCINE RESPONSE UNDER B- AND T-CELL TARGETED THERAPIES VERSUS ANTI-CYTOKINE THERAPIES IN PATIENTS WITH INFLAMMATORY ARTHRITIDES
Authors: R. Felten, M. Geoffroy, B. Loïs, P. M. Duret, M. Desmurs, A. Fan, M. Couderc, L. Messer, M. Ardizzone, S. Ahmed-Yahia, R. M. Javier, A. Meyer, E. Chatelus, C. Sordet, L. Pijnenburg, J. Sibilia, M. Soubrier, J. E. Gottenberg, J. H. Salmon
Journal: Annals of the Rheumatic Diseases (2022)

Background Vaccination against SARS-CoV-2 is effective in preventing severe forms of COVID-19, but there remain concerns about a reduced vaccine response in patients suffering from inflammatory arthritides who are treated by immunosuppressive therapies. Objectives We analysed the impact of bDMARDs on the humoral anti-SARS-CoV-2 vaccine response of patients followed in day hospitals. Methods We studied the vaccine response after a complete vaccine regimen followed in day hospital in 5 French hospitals and treated with an intravenous bDMARD between September 2019 and August 2021. After obtaining their informed consent, we included patients with an anti-SARS-CoV-2 serology. They were considered non-responders if the antibody level detected was inferior to the threshold of positivity of the kit used. Results 205 patients were included (148 females/57 males). The median age was 64 years (Interquartile Range [IQR] 56-71). 25 were treated with tocilizumab (TCZ), 36 with abatacept (ABA), 53 with infliximab (IFX) and 91 with rituximab (RTX). When considering both patients after a complete vaccination schema (2 doses, or 1 dose in case of prior COVID-19) and those with 1 booster dose, 34 patients (16.6%) were non-responders (2 [5.9%] treated by IFX, none treated by TCZ, 9 [26.5%] treated by ABA and 23 [67.7%] treated by RTX). In multivariate analysis, the only characteristics that significantly and independently differed between responders and non-responders were last bDMARD and corticosteroid therapy at the time of 1 st vaccination (Table 1). In RTX-treated patients, the delay from last infusion to 1 st vaccine dose was significantly shorter in non-responders (median 4.3 IQR [2.9-6.1] months in non-responders versus 8.4 IQR [5.7-14.5] in responders, p=0.0007). Median survival, i.e. achieving a vaccine response in 50% of RTX-treated subjects, was achieved after 277 days (95CI [209-310]) in patients vaccinated with 2 or 3 doses (Figure 1). In ABA-treated patients, the delay from last infusion to 1 st vaccine dose was not different between non-responders and responders. Table 1. Patients’ characteristics and comparisons between responders and non-responders. All patients (n=205) Responders (n=171) Non responders (n=34) Univariate p value Multivariatep value Age (median [IQR]), in years 64 [56-71] 64 [54-70] 69 [57-75.5] 0.07 0.40 Female sex, n (%) 148 (72.2) 125 [73.1) 23 (67.7) 0.53 Inflammatory arthritides, n (%) 0.16** 0.24 Rheumatoid Arthritis 156 (78.0) 128 (74.9) 28 (82.4) 0.51 Spondyloarthritis 33 (16.1) 31 (18.1) 2 (5.9) 0.12 Others* 16 (7.8) 12 (5.9) 4 (1.9) 0.31 Last bDMARDs at time of 1 st vaccination, n (%) 0.0004ABA/RTX versus IFX/TCZ &lt; 0.0001 0.00024 Infliximab 53 (25.9) 51 (29.8) 2 (5.9) Tocilizumab 25 (12.2) 25 (14.6) 0 Abatacept 36 (17.6) 27 (15.8) 9 (26.5) Rituximab 91 (44.4) 68 (39.8) 23 (67.7) Associated treatments at time of 1 st vaccination CsDMARDs, n (%) 126 (61.5) 107 (62.6) 19(55.9) 0.56 Methotrexate 91 (44.4) 78 (45.6) 13 (38.2) 0.46 Median dose in users (mg /week) [IQR] 15 [10-17.5] 13.8 [10-15.6] 15 [13.8-20] 0.07 Corticosteroids, n (%) 25 (12.2) 19 (11.1) 6 (17.6) 0.29 Median dose (mg /day) [IQR] 0 [0-0] 0 [0-0] 0 [0-2] 0.035 0.016 Previous COVID-19 infection, n (%) 23 (11.2) 21 (12.3) 2 (5.9) 0.38 Type of vaccine, n (%) 0.62 Pfizer 169 (82.4) 142 (83.0) 27 (79.4) 0.62 Moderna 14 (68.3) 11 (6.4) 3 (8.8) 0.71 Astra-Zeneca 17 (8.3) 15 (8.8) 2 (5.9) 0.74 Janssen 5 (2.4) 3 (1.8) 2 (5.9) 0.19 Vaccination, n (%) Complete 167 (81.5) 141 (82.5) 28 (16.8) 0.47 Complete + 1 booster dose 56 (27.3) 43 (25.1) 13 (38.2) 0.14 Figure 1. Cumulative seropositive rate according to the interval (days) between the last course of rituximab administration and vaccination Conclusion ABA and RTX alter the anti-SARS-CoV-2 vaccine response and were associated with nearly all vaccine non-responses in the present study. Corticosteroid therapy was associated with a lower vaccine response regardless of its indication or the concomitant use of bMARD. Disclosure of Interests None declared